California Clinic System Embraces Online Consultations

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A major safety-net insurer in Los Angeles is adopting secure online communications to streamline referrals from primary care physicians to medical specialists, in hopes of preventing unnecessary visits and reducing wait times for those truly in need of specialty care.

L.A. Care Health Plan, which, with 900,000 mostly low-income enrollees in Los Angeles County, considers itself the largest public health plan in the country, is spending $1.5 million to implement eConsult, an physician-to-physician consultation and referral network, at 47 safety-net healthcare facilities.

That represents nearly a quarter of all safety-net clinics in the nation's most populous county, and officials eventually hope to expand it.

"The vision is that it would be countywide," Sajid Ahmed, director of health information technology and e-health strategy at L.A. Care, told InformationWeek Healthcare. The initial rollout will include physicians affiliated with Health Care LA IPA and MedPoint Management, which provides management services to independent physician associations.

The eConsult system is a peer-to-peer communications platform that allows primary care physicians and practice staff to correspond with specialists in three ways: They can have specialists respond to their questions, they can ask for clinical advice such as which tests to run, and they can make referrals.

"More often than not, the specialist is able to provide information to the primary care physician," Ahmed said. If a patient does need to be referred, "the specialist already has the electronic workup," Ahmed added. "eConsult is the front end of the referral process."

The system essentially is a form of store-and-forward telehealth and secure e-mail communication, purposely kept simple to encourage adoption among technology-averse doctors. "It's a low threshold," Ahmed explained.

With eConsult, primary care physicians know what happens to patients within days of a referral, helping to support coordination of care. Without this system, getting word back often takes weeks or months, Ahmed said. "We're changing the behavior of how physicians do referrals," according to Ahmed. "It's not about the technology. It's about [physician] behavior."

The decision to build out eConsult comes after L.A. Care found success with a pilot among 40 small and solo physician practices in its provider network. Users, who took part in more than 1,000 electronic consultations, found that the system improved communication and information sharing among healthcare professionals, according to Ahmed. L.A. Care said the technology helped shorten wait times to resolve various healthcare issues and cut the number of specialist visits by as much as 48% in some specialties.

"eConsults enabled immediate access to specialty care for patients who would otherwise have had limited access and would have had to wait weeks to be seen. This allows for quicker diagnosis, leading to better clinical results," Dr. Daniel Behroozan, director at the Dermatology Institute of Southern California, said in an L.A. Care statement.

Specialists won't be directly reimbursed for the online consults--a major barrier to wider use of telemedicine and secure communications among many physicians--but Ahmed said there are good financial reasons for them to participate. "eConsult is not a standalone operation," he noted. L.A. Care, a public agency that provides health services for Medicaid enrollees, uninsured children, and Medicare Advantage members, requires referrals from primary care physicians. The consultations could help drive referrals to participating, according to Ahmed.

Also, MediCal, California's Medicaid program, has been increasing its use of bundled payments per healthcare episode, so specialists and primary care physicians have built-in incentives to coordinate care, Ahmed added.

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